There's nothing humorous about black bile!
Actually, if you're melancholic, there's perhaps too much that's humorous
Just a heads up, this one is…kind of gross!
Which is more black, more bottomless: Depression or melancholy?
Descriptions of depression are ample — more writers seem to have it than don’t — but in the many, there’s a common motif: Darkness.
Sometimes that takes the form of night or shadows, in other instances, this darkness is represented by an object or an image. In Ariel, Sylvia Plath described depression as “this dark thing that sleeps in me; All day I feel its soft, feathery turnings, its malignity.” Victor Hugo used the metaphor of the eye when, in Les Mis, he wrote that “the pupil dilates in darkness and in the end finds light, just as the soul dilates in misfortune and in the end finds God.”
Meanwhile, writing about melancholy skews a little differently. Often, the term “melancholy” means something lighter, less oppressive. A bad patch rather than, you know, a bad brain. Albert Camus wrote of the need to “distinguish melancholy from sadness,” and Susan Sontag described depression a “melancholy minus its charms.”
If you’ve always used these terms interchangeably (or, as is more likely, literally never used “melancholy” to describe depression because you are a product of the 21st century), you’re not incorrect. The difference, if any, between depression and melancholy is still up for some debate. Since the phrase went out of use, at least medically speaking, several decades ago, it hasn’t really been litigated that often in the public sphere. People basically use the term “melancholy” as they wish and everyone understand what they’re saying.
But!
This is interesting to compare because, while melancholy is often treated of the lighter, even more quaint condition, that wasn’t always the case. Waaaaaay back in the day, when Hippocrates was a practitioner and not just the guy they named the oath after, melancholy was an all-encompassing term that meant any prolonged sadness or lack of energy. And that shit was about as black as it could be because, according to the believers in Hippocratic medicine (or Humorists, as they were also called), melancholy was caused by a proliferation of black bile.
But um…what is black bile? Like, what is it actually?
Quickly, the ~humors~
You probably already know this, but the Humorist school of medicine — belief that most if not all diseases were caused by an imbalance of the body’s natural goo — was very popular for many, many, many years. Like for centuries, the best and brightest in medicine diagnosed and treated people using a rubric that separated the contents of the human body into four distinct-ish “humors” or vital fluids: blood, phlegm, yellow bile, and black bile.
In the absence of imaging technology or microscopes, medical practitioners were kind of limited to what they could see plainly (and draw out of a patient) in order to diagnose them. Like when my acupuncturist asked to see my tongue and I was like “excuse you” and he was like “well it’s an uncovered muscle so it’s kind of like getting to see inside of you” and I opened my mouth but remained perplexed.
Anyway, each of these humors was linked to a “temperament.” Any ill that a person was suffering may have been attributed to an imbalance of these. Like, say, if you were and doctors believed that balancing the humors could help someone set right mood and condition. If you had a fever, the doctor would decide that you had too much yellow bile and needed to eat something that would make you less so. This is why bloodletting, leeches, and other questionable practices were so popular. If you came in presenting as “sanguine,” i.e. potentially manic or overly excited, they literally believed you had too much blood and would unburden you of it. Which, yes, would make you less energetic, but not for the reasons they thought.
Doctors were using this method of diagnoses and treatment until — get this — the middle of the 1800s. That’s how baked in it was! It was only when germ theory came along (BLESS YOU, DR. JOHN SNOW) that this was mostly abandoned.
So what the hell is “black bile” anyway?
The phrase “melancholia” literally comes from the Greek “melaina chole,” which means “black bile.” I’m not a doctor, so I’m going to borrow this very clear description from a paper published by the Max Planck Institute:
This term originates from humoral theory, the predominant medical ideology from antiquity through the 19th century. According to generations of humoral practitioners, beginning with the Greek physician Hippocrates around 400 BCE, an excess of black bile was implicated in the melancholic temperament and related to depressive symptoms. Contemporaneously, Plato noted that black bile lends itself to “infinite varieties” of emotional distress and disorder; Celsus, the esteemed Roman writer of De Medicina libri octo, stated 400 years later that depressive symptoms were caused by black bile; and Galen, a highly influential Greek physician of the second century CE, suggested a theory of unbalanced “non-natural” elements responsible for depressive symptoms in parallel to humoral theory. Treatments in antiquity for such an ailment were predominated by bloodletting, purging, and exercise.
Black bile was believed to be secreted by either the kidneys or the spleen and, if you had too much of it, you needed to get it out of there so that you could shake that depression devil off. It was thought to be cold and dry as a substance, so a lot of treatments relating to water and warmth were prescribed to counteract it. Balancing of the black bile might be achieved (or thought to be achieved) through hot soaks, warm compresses, and exercise. Warm, soft foods were also recommended. Not so bad, right?
But here’s a question I can’t stop thinking about: Have you ever seen black bile?
Like has it ever come out of you? Because if I’m being honest, I have to say that I have literally no idea that this substance actually is, which is weird since I’ve been living in this human body for 30somthing years and I was pretty sure I knew all of the grotesque things it leaches and secretes. I know what blood is. I know what yellow bile is. I’m acquainted with phlegm. But…black? Bile?
As it turns out (yes, I did these Google searches on your behalf, YOU ARE WELCOME), there’s some controversy over what this even meant. It’s not like humans of 2,000 years ago made different juices than we do. So what was it referring to that was common enough to be believed to be a pillar of human health?
Because it so seldom showed up, it wasn’t even The Most Popular Humor. But then came Aelius Galenus, also known as Galen, (because old-times philosophers, like Cher, require only one name). Born in 129 AD, Galen was a Hippocratic practitioner as well as a very fancy thinking man who often took substantial logical leaps because back then no one really cared. He thought black bile was especially interesting and potent and wrote a lot about it (how you could draw it out of a person, what it might mean). That has left a lot of textual evidence for modern-day researchers to dive through. And most of them have concluded that it’s…
Blood. Yes, just blood that looked weird or sat out in the heat too long or had a lot of extra crap in it or touched the air or had an excessive amount of hemoglobin.
In a study based off of contemporary text, researchers from Bangalore found that “black bile is the sediment of normal blood.”
It is the last to arise and receives the coarse, most meagre share of nutrients and has a retentive virtue, a cooling, drying, astringing, precipitating, condensing, solidifying effect on the metabolism necessary for building the bones, teeth and all dense, solid structures of the body.
It may also be that black bile was the result of internal bleeding and, often, vomiting that up. If that happened, you would definitely think something was wrong with you. And it does happen!
So gross! I would be depressed, too, if that came out of me!
That’s still just blood though.
So really, there were only three humors. It’s just that blood is kind of a wild substance that takes on all shapes and sizes and also that when your blood turns bad, you probably have something wrong with you.
But how did that actually tie into mood disorders?
The short answer is that it did not, of course. The human brain and its ability to conduct serotonin and other chemicals is responsible for depression. That’s also why depression can sometimes come with lots of psychical symptoms — because yes, technically, it’s all in your head, but also, those symptoms (lack of apetite, physical pain) can have a compounding or ripple effect. Depression begins in the brain but can quickly become a very real condition in the body.
Which is also why people probably sought treatment. If you’ve never suffered from a serious bout of depression and then one day you’re very, very sad but also your head hurts and you can’t sleep and you feel dizzy, you may think it’s like, a tumor or something.
If you were a depressed person — showing the clear mental and physical signs we now attribute with clinical depression — from the Before Times right up until your great-grandparents were alive, you black mood may have been attributed to black bile. The treatment to correct the imbalance might have been things that potentially help a bit — walking around outside, eating a nutritious diet — but absent an actual medication (and in the presence of, you know, bloodletting), it’s unlikely that you’d really recover.
Add in the lack of talk therapy and other supportive treatments and it’s not a huge surprise that everyone who presented with “black bile” was considered very, very sick. After all, there was not a good prognosis. And if you were bleeding internally and they just told you to take a hot bath, that was probably not going to do a lot for you, either.
Mental health stigma is still super-real — there are always at least a few people who look QUITE uncomfy if I mention my SSRI at a party! — but whenever I look back at the medicines and theories from the entire rest of human history, I’m glad that at least we can conduct imaging, do tests on the blood, and generally figure out what’s going on with ourselves. We haven’t fixed it yet, but it’s certainly not as bad as it was. That “dark thing” that lives in side of us may still feel huge and scary, but at least it’s not such a mystery.